Background Adolescent substance use is a growing public health concern in Sri Lanka, yet little is known about how youth are first exposed to and continue using illicit substances. Methods This qualitative study explored the initiation and continuation of substance use among adolescents aged 10–17 years with a history of drug abuse. 48 adolescents were interviewed at the Youth Drug Addiction Prevention, Treatment (2) peer modelling and social apprenticeship; (3) coercion and manipulated consent; (4) emotional triggers including grief and relationship stress and (5) sustained use driven by coping needs, pleasure and physical dependence. Initiation often occurred in familiar environments such as schools, temples and homes, with many adolescents describing use as functional rather than recreational. Conclusions Adolescent substance use in Sri Lanka is shaped by complex psychosocial and environmental influences. Prevention and intervention strategies must address not only individual behaviour but also social networks, emotional vulnerability and structural access to drugs in community settings.
Anand et al. (2026) studied this question.